Treatment of recalcitrant plaque psoriasis with a humanized non-depleting antibody to CD4.
The presence of activated CD4(+) T lymphocytes in psoriatic skin plaques suggests an immune-mediated pathogenesis for the disease. Six patients with recalcitrant plaque psoriasis (PASI>12) received a humanized non-depleting monoclonal antibody to CD4 (ORTHOCLONE OKT(R)cdr4a). The antibody was well tolerated. Four weeks from treatment, the mean decrease in PASI score was 46%. In three patients disease remission was prolonged for up to 6 months and, in one case, up to 1 year post-treatment. In all patients, circulating CD4+ T-cell counts remained normal and peripheral OKTcdr4a-coated CD4+ lymphocytes were detected up to 10 days after antibody infusion. These results point to the relevance of CD4+ lymphocytes in psoriasis. They also emphasize that depletion of CD4+ cells is not mandatory to achieve therapeutic effectiveness.
Bachelez
H
H
Service Dermatologie, Hôpital Saint-Louis, Paris, France.
Flageul
B
B
Dubertret
L
L
Fraitag
S
S
Grossman
R
R
Brousse
N
N
Poisson
D
D
Knowles
R W
RW
Wacholtz
M C
MC
Haverty
T P
TP
Chatenoud
L
L
Bach
J F
JF
D000328:Adult; D000818:Animals; D000888:Antibodies, Anti-Idiotypic / Q000096:biosynthesis; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000235:genetics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015704:CD4 Antigens / Q000097:blood; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008212:Lymphocyte Depletion; D008297:Male; D051379:Mice; D015166:Monitoring, Immunologic; D011565:Psoriasis / Q000276:immunology* / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D012720:Severity of Illness Index; D012867:Skin / Q000737:chemistry / Q000378:metabolism / Q000473:pathology; D013601:T-Lymphocytes / Q000378:metabolism
D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D015704:CD4 Antigens; C079851:OKT4A monoclonal antibody